Practice Challenges and Research Directions in Rural Drug and Alcohol Treatment: A Focus Group Study of Clinician...

Substance use and related mental illness contribute substantially to Australia's disease burden, with disproportionately high impacts in rural areas where access to specialist care is limited. Understanding local service challenges is critical to improving care delivery and guiding contextually relevant research. The aims of this study were to identify: (i) practice challenges; (ii) practice improvement priorities; and (iii) research priorities among rural drug and alcohol clinicians in Western NSW Local Health District.

A pragmatic qualitative study was conducted using structured focus groups informed by a modified Delphi approach. Three focus groups (two in-person, one online) were held with 16 clinicians from diverse drug and alcohol programs. Discussions were guided by regional treatment data and a clinician workforce survey. Data were audio-recorded, transcribed and analysed using deductive qualitative content analysis, with findings validated through participant member checking.

Four themes were identified. Service gaps and access barriers included fragmented mental health and drug and alcohol systems, transport limitations, stigma and cultural safety concerns for Aboriginal clients. Workforce and training needs reflected staff shortages, limited preparation for integrated care and insufficient support for vicarious trauma. Technology and innovation were viewed as promising, particularly telehealth, but were constrained by cost, policy and implementation uncertainty. Research priorities focused on developing and evaluating integrated care models, virtual and brief interventions, culturally responsive services, workforce wellbeing and social determinants including housing, transport and stigma.

Persistent structural and workforce challenges shape rural service delivery. Addressing these requires pragmatic, locally grounded research and stronger partnerships between health services and universities to support implementation of context-specific solutions.